Superiority of Brain and Spinal Injury Center Score for Assessing Injury Severity and Predicting Prognosis in Patients with Acute Traumatic Spinal Cord Injury

• Published in: Clinical neuroradiology (Munich) 2022-12, Vol.32 (4), p.1117-1125
• Main Authors: Zhan, Sizheng, Xie, Wenyong, Xue, Feng, Zhang, Dianying, Jiang, Baoguo
• Format: Article
• Language: English
• Subjects: Brain - pathology; Brain Injuries; Cohort Studies; Hospitals; Humans; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Neurology; Neuroradiology; Neurosurgery; Original Article; Orthopedics; Patients; Principal components analysis; Prognosis; Retrospective Studies; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal cord injuries; Spinal Cord Injuries - diagnostic imaging; Spinal Cord Injuries - pathology; Spinal Injuries; Statistical analysis; Steroids; Surgery; Validity
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-022-01154-1

Purpose The goal of this study was to evaluate the interrelationship between different magnetic resonance (MR) imaging measures and their validity in assessing the severity of acute traumatic spinal cord injury (tSCI) and predicting neurological outcomes. Methods We performed a preoperative multicenter cohort study of 89 patients with acute tSCI and preoperative MR imaging within 24 h after injury. We assessed several MR imaging measures of injury, including axial grade (Brain and Spinal Injury Center [BASIC] score), sagittal grade, length of injury, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). Principal component analysis (PCA) was applied to evaluate the interrelationship between different MR imaging measures. Spearman correlation and regression analyses were applied to assess injury severity and predict neurological impairment. The severity was assessed by the American Spinal Injury Association Impairment Scale (AIS) at admission, while neurological outcome was defined by AIS grade change at 6 weeks, AIS grade and SCIM score at 1 year after surgery. Results The PCA identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality (BASIC score, sagittal grade and length of injury) and 2) measures of extrinsic cord compression (MCC and MSCC). Neurological outcome and injury severity were best accounted for by MR imaging measures of intrinsic cord signal abnormalities, with the BASIC score representing the most accurate predictor of short-term and long-term neurological outcomes. Conclusion We determined the superior significance of the BASIC score in assessing injury severity, predicting early AIS improvement, AIS grade and SCIM score at 1 year compared with other MR imaging measures.